Healthcare has been at the centre of public service programs by National authorities and NGOs for decades. The technical innovations and the knowledge gained by experts in the eld made healthcare a very advanced modern science. And those advancements made healthcare a demanding industry for insurance companies to be in.
Insurance companies and TPA's often require challenging updates and changes in their software and claim processing infrastructure to cope with the pace of fast forwarding health care industry and healthcare authorities. Smart Health provides Insurance companies and Third Party Administrators with comprehensive support in software and claim processing infrastructure for their healthcare operations. The experience acquired by working with several partners in the industry and the technical expertise helps the Smart Health to continuously improve and perfect itself. Smart Health has the ability to be customised heavily according to the needs of the industry and that makes it one of the most exible systems of its kind.
Solutions that are on offer are:
Smart Health Software Access for managing Medical Claims
• Customized Smart Health Software as required by the client (Insurance Companies or Third Party Administrators)
• Set up various stakeholders within the system, Insurance Company, Branches, Providers, Brokers and Reinsurers
• Set up Medical Service Provider Pricing
• Module to set up Insurance Policy Table of Benefits
• Module for membership management including additions and deletions
• Module for "Pre-Approvals"
• Module for document management control
• Claims processing Module
Paper Claims Processing Platform
• Each claim/invoice bar coded and scanned and made available in Smart Health.
• Utilizing Smart Health software, claims are processed including coding of diagnosis as per ICD standard codes
• System validates each Claim/Invoice by Table of Benefits, Pricing agreed with Providers
• Communication window "Dialog Box" for each claim
• Patient past history, pre-approvals view
• The claims data entry/processing by trained and qualified team of medical claims processors
• The data integrated to Insurance Company/Third Party Administrators' system as per the agreed format
E-Claim Processing Platform
• Set-up Smart E-Claim platform for Insurance Company, its branches, brokers, reinsurers
• Set-up Smart E-Claim platform for Medical Service Providers including pricing agreed
• Set-up Smart E-Claim Platform with all Table of Benefits of various insurance policies
• Module to download XML claims files from central portal
• Module to view downloaded claims and process claims based on the client Table of Benefits and pricing agreed with the medical provider